Fewer Latinos join health exchange than expected

Latinos remain underrepresented among the more than 500,000 Californians who have signed up for health coverage under the Affordable Care Act, according to data released Tuesday.

Peter Lee, executive director of Covered California, the state’s health insurance exchange, said that 500,108 Californians had enrolled for coverage from Oct. 1 through Dec. 31.

Of those, nearly 400,000 answered questions about their ethnicity. About 20 percent of those enrolled said they were of “Hispanic, Latino or Spanish origin,” while the rate was 30 percent among those who have applied but not yet enrolled.

Whether the true percentage of Latinos buying plans is 20 percent or 30 percent, it’s still significantly lower than expected, Lee said. Estimates by economists at UCLA, he said, show that about 2.6 million Californians are eligible for subsidized exchange coverage, and 46 percent of them are Latino.

That means 1.1 million of Obamacare’s target demographic are Latino. If sign-up rates stay at 30 percent through the next few years, that would leave more than 400,000 subsidy-qualified Californians uninsured and thus outside a risk pool that relies on size to keep premiums low.

Lee said the exchange is working with community groups to reach out more directly to Latinos.

“In-person enrollment is going to be more important for Spanish speakers in their communities,” Lee said.

Fernando Sañudo, chief executive of Vista Community Clinic, said there are some well-known factors that can hold back Latino enrollment. Though only legal immigrants qualify for Obamacare coverage, he said that some families may have a member who is in the citizenship or visa application process.

“They’re concerned that applying for any kind of government program will affect their ability to actually get their residency card or their visa,” Sañudo said.

Others, he said, may find it difficult to pay even low premiums charged by exchange policies, and many have not been fully educated on the benefits of having health coverage.

Despite the Latino trend, California appears to be meeting its enrollment goals. Lee said 125,000 Californians picked plans in the first two weeks of January, bringing the total enrolled to 625,000. That’s close to the top end of UCLA’s predictions that between 500,000 and 700,000 would sign up by March 31, the final day of the Affordable Care Act’s inaugural enrollment period.

Covered California also reported that 25 percent of those who signed up were between 18 to 34, an age range seen as critical for maintaining premium prices in 2015 and beyond. The theory is that if too few young people, who generally are healthier than the overall population, sign up then prices might have to increase.

While the 25 percent sign-up rate is higher than the 21 percent who had signed up through the end of November, Lee said that 36 percent of those eligible for subsidies are thought to be between 18 and 34 years old.

Lee said that it was always expected that younger people would take longer to sign up.

“This is a new thing for young people,” he said.

He said insurance companies know that will take years for enrollment among younger Californians to ramp up and have built that knowledge into today’s rates. Lee said a number under 36 percent for those age 18 to 34 does not necessarily mean a big premium spike in 2015.

“There is a recognition that the risk mix won’t be a full risk mix in year one,” Lee said.

To date, 85 percent of those who have bought policies from Covered California have qualified for income-based subsidies that help cover the cost of premiums, and co-pays in some instances. But those who do not qualify for a subsidy, and don’t get coverage from the employer or a government program like Medicare, still must have insurance or pay a penalty starting Jan. 1.

Lee said Covered California is working with carriers to determine how many in the state have purchased coverage in the individual market outside the exchange and that data should be available in February.